Clinical and lung function outcomes in a cohort of children with severe asthma

• Published in: BMC pulmonary medicine Vol. 20; no. 1; pp. 66 - 9
• Main Authors: de Gouveia Belinelo, Patricia, Nielsen, Aleisha, Goddard, Bernadette, Platt, Lauren, Da Silva Sena, Carla Rebeca, Robinson, Paul D, Whitehead, Bruce, Hilton, Jodi, Gulliver, Tanya, Roddick, Laurence, Pearce, Kasey, Murphy, Vanessa E, Gibson, Peter G, Collison, Adam, Mattes, Joerg
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 18-03-2020; BioMed Central; BMC
• Subjects: Administration, Inhalation; Adolescent; Asthma; Asthma - drug therapy; Asthma - nursing; Asthma - physiopathology; Australia; Bronchodilator Agents - therapeutic use; Bronchodilators; Care and treatment; Child; Child, Preschool; Childhood; Childhood asthma; Children; Female; Humans; Lung - physiopathology; Lung function; Male; Medical research; Methods; Multidisciplinary clinic; Nurses; Outpatient Clinics, Hospital; Patient outcomes; Pediatric nursing; Pediatric research; Pediatrics; Practice Patterns, Nurses; Pulmonology; Respiratory function; Respiratory Function Tests; Retrospective Studies; Severe asthma; Spirometry; Time; Treatment Outcome; Australia; Multidisciplinary clinic; Lung function; Severe asthma; Childhood asthma
• ISSN: 1471-2466; 1471-2466
• DOI: 10.1186/s12890-020-1101-6

Uncontrolled severe asthma in children is burdensome and challenging to manage. This study aims to describe outcomes in children with uncontrolled severe asthma managed in a nurse-led severe asthma clinic (SAC).
This retrospective analysis uses data collected from children referred by a paediatric respiratory specialist to a nurse-led SAC for uncontrolled severe asthma between 2014 and 2019. The pre-clinical assessments included a home visit to assess modifiable factors that could be addressed to improve control. A comprehensive lung function analysis was conducted at each visit. Interventions were personalised and included biologic agents. Statistical analysis was performed using nonparametric, two-tailed Mann-Whitney U-test, the parametric Student's t-test, or analysis of variance (ANOVA) as appropriate.
Twenty-three children with a median age of 12 years were seen once, and 16 were followed up. Compared to a non-asthmatic (NA) and asthmatic (A) age-matched cohort, children with severe asthma (SA) had a lower FEV1, and FVC% predicted before and after bronchodilator inhalation, and a higher mean Lung Clearance Index [LCI] (10.5 [SA] versus 7.3 [NA] versus 7.6 [A], p = 0.003). Almost 80% of children with SA had an abnormal LCI, and 48% had a reduced FEV1% at the first SAC visit. Asthma control and FEV1% predicted significantly improved at a follow-up visit, while LCI remained abnormal in the majority of children (83%).
Over time, many children with severe asthma showed improved clinical outcomes and lung function while lung ventilation inhomogeneities persisted. Future appropriately controlled studies are required to determine if a nurse-led multidisciplinary SAC is associated with better outcomes.